Interstitial brachytherapy (ISBT) is a known treatment for vaginal recurrence of endometrial cancer. This study reviews a large tertiary institution's ISBT experience and outcomes for vaginal recurrences.
MATERIAL AND METHODS
Patients who underwent salvage ISBT for vaginal recurrence of endometrial cancer from January 1, 2014 to August 31, 2021, were identified. Initial and salvage disease factors and treatments were recorded. Outcomes were calculated including overall survival, local, and distant failure.
RESULTS
Thirty-nine patients were included; thirty received external beam radiotherapy and interstitial brachytherapy (EBRT + ISBT) while 9 received ISBT alone. At initial diagnosis, the ISBT alone group had an older median age, with stage IA-IV disease, frequently receiving adjuvant treatment, compared to the EBRT with ISBT group with mainly stage IA disease who did not. Median follow up was 22 months and median time to recurrence 14 months (16.5 months in EBRT + ISBT group and 14 in the ISBT alone group). Two-year overall survival was 85% for all patients, 85.6% and 83.3%in the EBRT + ISBT and ISBT alone groups, respectively. Local failure was 22.7% for all patients, 16.7% in the EBRT + ISBT group and 11.1% in the ISBT alone group. Median HRCTV D90 (EQD2) was 76.8 Gy in the EBRT + ISBT group, and 57.9 Gy in the ISBT alone group. Late grade 3 or higher toxicity occurred in only 3 patients.
CONCLUSIONS
EBRT + ISBT is an effective treatment for endometrial cancer vaginal recurrence, with acceptable toxicity. ISBT alone is an option for patients with contraindications to or with previous treatment of pelvic radiation.
{"title":"Salvage interstitial brachytherapy for treatment of recurrent endometrial cancers in the vagina: Seven-year single institution experience and review of second recurrence patterns","authors":"Marissa Sherwood , Toni Barnes , Hanbo Chen , Amandeep Taggar , Moti Paudel , Liying Zhang , Aishah Alqaderi , Eric Leung","doi":"10.1016/j.brachy.2024.09.007","DOIUrl":"10.1016/j.brachy.2024.09.007","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Interstitial brachytherapy (ISBT) is a known treatment for vaginal recurrence of endometrial cancer. This study reviews a large tertiary institution's ISBT experience and outcomes for vaginal recurrences.</div></div><div><h3>MATERIAL AND METHODS</h3><div>Patients who underwent salvage ISBT for vaginal recurrence of endometrial cancer from January 1, 2014 to August 31, 2021, were identified. Initial and salvage disease factors and treatments were recorded. Outcomes were calculated including overall survival, local, and distant failure.</div></div><div><h3>RESULTS</h3><div>Thirty-nine patients were included; thirty received external beam radiotherapy and interstitial brachytherapy (EBRT + ISBT) while 9 received ISBT alone. At initial diagnosis, the ISBT alone group had an older median age, with stage IA-IV disease, frequently receiving adjuvant treatment, compared to the EBRT with ISBT group with mainly stage IA disease who did not. Median follow up was 22 months and median time to recurrence 14 months (16.5 months in EBRT + ISBT group and 14 in the ISBT alone group). Two-year overall survival was 85% for all patients, 85.6% and 83.3%in the EBRT + ISBT and ISBT alone groups, respectively. Local failure was 22.7% for all patients, 16.7% in the EBRT + ISBT group and 11.1% in the ISBT alone group. Median HRCTV D90 (EQD2) was 76.8 Gy in the EBRT + ISBT group, and 57.9 Gy in the ISBT alone group. Late grade 3 or higher toxicity occurred in only 3 patients.</div></div><div><h3>CONCLUSIONS</h3><div>EBRT + ISBT is an effective treatment for endometrial cancer vaginal recurrence, with acceptable toxicity. ISBT alone is an option for patients with contraindications to or with previous treatment of pelvic radiation.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 36-44"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.brachy.2024.10.004
Raphael William , Pierre-Yves McLaughlin , Mathieu Pharand-Charbonneau , Debbie Smith Wright , Alain Haddad , Marc Gaudet
PURPOSE
To determine the long-term disease-free survival, long-term toxicity, and effect on health-related quality of life of a two-fraction regimen of high-dose-rate (HDR) prostate brachytherapy.
METHODS AND MATERIALS
Patients with low- or intermediate-risk prostate cancer were treated with CT-planned HDR brachytherapy as monotherapy in two implants of 13.5 Gy in one community cancer center. Prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and Expanded Prostate Index Composite (EPIC) questionnaires were evaluated at each follow-up visit. Biochemical recurrence (Phoenix definition) was evaluated to determine disease-free survival at 5 and 7 years. Proportion of patients in each IPSS category (mild = 0–7, moderate = 8–18, severe = 19+) was evaluated at each follow-up interval.
RESULTS
Thirty patients were accrued to the study between 2014 and 2016. Median prostate-specific antigen was 8,7 (range 4.1–17.5). T stages were T1c = 65%, T2a = 21%, and T2b = 14%. Twenty-seven percent of patients had a Gleason score of 6 and 73% had a Gleason score of 7. 13% were in low risk category and 87% in intermediate risk category. Median follow-up was 84 months. There were no deaths at 84 months after brachytherapy. Disease-free survival was 90% at 5 years and 86% at 7 years. Two patients experienced late Grade 3 GU toxicity (6.6%).
CONCLUSIONS
This study serves as proof of concept that HDR monotherapy can be performed successfully with excellent long-term outcomes in a community cancer center with adequate training and experience. The long-term disease-free survival rate and the health-related quality of life seem acceptable as compared to other treatment modalities. Further study is ongoing with regard to the optimal dosing regimen for HDR monotherapy.
{"title":"Long-term disease-free survival and health-related quality of life results of high-dose-rate brachytherapy as monotherapy for low and intermediate-risk prostate cancer treated in a community cancer center","authors":"Raphael William , Pierre-Yves McLaughlin , Mathieu Pharand-Charbonneau , Debbie Smith Wright , Alain Haddad , Marc Gaudet","doi":"10.1016/j.brachy.2024.10.004","DOIUrl":"10.1016/j.brachy.2024.10.004","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To determine the long-term disease-free survival, long-term toxicity, and effect on health-related quality of life of a two-fraction regimen of high-dose-rate (HDR) prostate brachytherapy.</div></div><div><h3>METHODS AND MATERIALS</h3><div>Patients with low- or intermediate-risk prostate cancer were treated with CT-planned HDR brachytherapy as monotherapy in two implants of 13.5 Gy in one community cancer center. Prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and Expanded Prostate Index Composite (EPIC) questionnaires were evaluated at each follow-up visit. Biochemical recurrence (Phoenix definition) was evaluated to determine disease-free survival at 5 and 7 years. Proportion of patients in each IPSS category (mild = 0–7, moderate = 8–18, severe = 19+) was evaluated at each follow-up interval.</div></div><div><h3>RESULTS</h3><div>Thirty patients were accrued to the study between 2014 and 2016. Median prostate-specific antigen was 8,7 (range 4.1–17.5). T stages were T1c = 65%, T2a = 21%, and T2b = 14%. Twenty-seven percent of patients had a Gleason score of 6 and 73% had a Gleason score of 7. 13% were in low risk category and 87% in intermediate risk category. Median follow-up was 84 months. There were no deaths at 84 months after brachytherapy. Disease-free survival was 90% at 5 years and 86% at 7 years. Two patients experienced late Grade 3 GU toxicity (6.6%).</div></div><div><h3>CONCLUSIONS</h3><div>This study serves as proof of concept that HDR monotherapy can be performed successfully with excellent long-term outcomes in a community cancer center with adequate training and experience. The long-term disease-free survival rate and the health-related quality of life seem acceptable as compared to other treatment modalities. Further study is ongoing with regard to the optimal dosing regimen for HDR monotherapy.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 54-61"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.07.007
Steven Blum , Jessica R. Miller , Kristin A. Bradley , Bethany Anderson , Hari Menon , Bradley Eckelmann , Charles Wallace , Abby Besemer , Michael Lawless , Jordan M. Slagowski
PURPOSE
The purpose of this work was to evaluate whether inter-fraction imaging and replanning enhance treatment delivery adherence to clinical planning objectives in the context of a 5-fraction template-based interstitial brachytherapy (TISB) approach for gynecologic cancer treatment.
METHODS AND MATERIALS
This retrospective study analyzed nineteen patients who underwent 5 fractions of interstitial brachytherapy over 3 days using the Syed–Neblett template. A verification CT scan was acquired for applicator assessment and reviewed by a radiation oncologist and medical physicist before each fraction. Eleven patients required replanning at least once during the treatment course. Replanning on the verification CT scan consisted of generating new target and organ-at-risk contours, digitizing catheter positions, and optimizing source dwell times to meet planning objectives. Dwell times and positions from the initial treatment plan were evaluated on the new contours to assess the dose that would have been delivered without replanning (nonadapted). Significance of nonadapted versus adapted dose differences were evaluated using a 2-sided Wilcoxon sum rank test.
RESULTS
The average (min, max) change in dose (Gy) between the clinically delivered plans and the nonadapted plans were HR-CTV D90%: −6.5 (−0.6, −15.1), HR-CTV D98%: −6.5 (−0.4, −12.6), Bladder D2cc: −0.5 (0.0, −2.8), Bowel D2cc: −0.8 (0.0, −3.2), Rectum D2cc: −1.1 (0.0, −11.5), Sigmoid D2cc: −1.4 (−0.1, −5.4). Dosimetric changes in HR-CTV coverage were significantly improved with replanning while organ-at-risk differences were nonsignificant (p > 0.05). Fraction 3 was the most common fraction indicated for replanning.
CONCLUSIONS
Replanning template-based interstitial brachytherapy can improve target coverage and adherence to planning goals.
{"title":"Dosimetric evaluation of adaptive planning for five-fraction gynecologic template-based interstitial brachytherapy","authors":"Steven Blum , Jessica R. Miller , Kristin A. Bradley , Bethany Anderson , Hari Menon , Bradley Eckelmann , Charles Wallace , Abby Besemer , Michael Lawless , Jordan M. Slagowski","doi":"10.1016/j.brachy.2024.07.007","DOIUrl":"10.1016/j.brachy.2024.07.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The purpose of this work was to evaluate whether inter-fraction imaging and replanning enhance treatment delivery adherence to clinical planning objectives in the context of a 5-fraction template-based interstitial brachytherapy (TISB) approach for gynecologic cancer treatment.</div></div><div><h3>METHODS AND MATERIALS</h3><div>This retrospective study analyzed nineteen patients who underwent 5 fractions of interstitial brachytherapy over 3 days using the Syed–Neblett template. A verification CT scan was acquired for applicator assessment and reviewed by a radiation oncologist and medical physicist before each fraction. Eleven patients required replanning at least once during the treatment course. Replanning on the verification CT scan consisted of generating new target and organ-at-risk contours, digitizing catheter positions, and optimizing source dwell times to meet planning objectives. Dwell times and positions from the initial treatment plan were evaluated on the new contours to assess the dose that would have been delivered without replanning (nonadapted). Significance of nonadapted versus adapted dose differences were evaluated using a 2-sided Wilcoxon sum rank test.</div></div><div><h3>RESULTS</h3><div>The average (min, max) change in dose (Gy) between the clinically delivered plans and the nonadapted plans were HR-CTV D<sub>90%</sub>: −6.5 (−0.6, −15.1), HR-CTV D<sub>98%</sub>: −6.5 (−0.4, −12.6), Bladder D<sub>2cc</sub>: −0.5 (0.0, −2.8), Bowel D<sub>2cc</sub>: −0.8 (0.0, −3.2), Rectum D<sub>2cc</sub>: −1.1 (0.0, −11.5), Sigmoid D<sub>2cc</sub>: −1.4 (−0.1, −5.4). Dosimetric changes in HR-CTV coverage were significantly improved with replanning while organ-at-risk differences were nonsignificant (<em>p</em> > 0.05). Fraction 3 was the most common fraction indicated for replanning.</div></div><div><h3>CONCLUSIONS</h3><div>Replanning template-based interstitial brachytherapy can improve target coverage and adherence to planning goals.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 668-675"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.07.002
Elena Dizendorf , Supriya Chopra , Prachi Mittal , Ankita Gupta , Remi Nout , Alina Sturdza , Cyrus Chargari , Kari Tanderup , Ekkasit Tharavichitkul , Hamza Tatli , Meenakshi Jeeva , Jeevanshu Jain , Subhajit Panda , Ritu Raj Upreti , Yogesh Ghadi , Akshay Bhavke , Satish Kohle , Rajesh Bhajbhuje , Jai Prakash Agarwal
PURPOSE
The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022–2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.
MATERIALS AND METHODS
Participants were radiation oncologists (RO) and medical physicists (MP) with experience in gynecological BT aiming to transition to image-guided brachytherapy (IGBT). The training covered cervical, endometrial, vaginal, vulvar, periurethral cancers, and pelvic reirradiation. The hybrid course included online pre and postcourse homework assignments, a live workshop with hands-on training, a 6-month online follow-up, and a 12-month opportunity to share the transition experience.
RESULTS
The December 2022 Mumbai live workshop spanned 2.5 days, attracting 39 participants from 8 countries (Asia, Africa, Australia/Oceania). Feedback rated the course 9/10, with 78% fully meeting expectations. Forty-four percent suggested extending hands-on training. At the 6-month follow-up, response rates were low (33% RO, 11% MP). Among responding RO, 70% reported practice changes after attending the course, 40% implemented IGBT concepts in clinical practice, and 50% increased confidence in image-guided procedures. Overall, 45% of respondent sites could strengthen their intracavitary/interstitial program, while others faced limitations due to lack of access to advanced BT applicators.
CONCLUSION
The hybrid gynecological BT training concept was successfully executed. Areas for improvement include extending hands-on training and enhancing participant engagement postcourse. Structured steps beyond training may be needed to improve the utilization of advanced brachytherapy for gynecological cancers.
{"title":"Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience","authors":"Elena Dizendorf , Supriya Chopra , Prachi Mittal , Ankita Gupta , Remi Nout , Alina Sturdza , Cyrus Chargari , Kari Tanderup , Ekkasit Tharavichitkul , Hamza Tatli , Meenakshi Jeeva , Jeevanshu Jain , Subhajit Panda , Ritu Raj Upreti , Yogesh Ghadi , Akshay Bhavke , Satish Kohle , Rajesh Bhajbhuje , Jai Prakash Agarwal","doi":"10.1016/j.brachy.2024.07.002","DOIUrl":"10.1016/j.brachy.2024.07.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022–2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Participants were radiation oncologists (RO) and medical physicists (MP) with experience in gynecological BT aiming to transition to image-guided brachytherapy (IGBT). The training covered cervical, endometrial, vaginal, vulvar, periurethral cancers, and pelvic reirradiation. The hybrid course included online pre and postcourse homework assignments, a live workshop with hands-on training, a 6-month online follow-up, and a 12-month opportunity to share the transition experience.</div></div><div><h3>RESULTS</h3><div>The December 2022 Mumbai live workshop spanned 2.5 days, attracting 39 participants from 8 countries (Asia, Africa, Australia/Oceania). Feedback rated the course 9/10, with 78% fully meeting expectations. Forty-four percent suggested extending hands-on training. At the 6-month follow-up, response rates were low (33% RO, 11% MP). Among responding RO, 70% reported practice changes after attending the course, 40% implemented IGBT concepts in clinical practice, and 50% increased confidence in image-guided procedures. Overall, 45% of respondent sites could strengthen their intracavitary/interstitial program, while others faced limitations due to lack of access to advanced BT applicators.</div></div><div><h3>CONCLUSION</h3><div>The hybrid gynecological BT training concept was successfully executed. Areas for improvement include extending hands-on training and enhancing participant engagement postcourse. Structured steps beyond training may be needed to improve the utilization of advanced brachytherapy for gynecological cancers.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 648-659"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S1538-4721(24)00435-5
{"title":"GF479-Elsevier-www.theclinics.com-Our Issues Can Help You Manage…-BW","authors":"","doi":"10.1016/S1538-4721(24)00435-5","DOIUrl":"10.1016/S1538-4721(24)00435-5","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page I"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.06.007
Tugce Kutuk , Rupesh Kotecha , Roberto Herrera , D Jay J. Wieczorek , Zachary W. Fellows , Vibha Chaswal , Alonso La Rosa , Vivek Mishra , Michael W. McDermott , Vitaly Siomin , Minesh P. Mehta , Alonso N. Gutierrez , Ranjini Tolakanahalli
PURPOSE
Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities.
METHODS
Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnifeⓇ (CK), Gamma KnifeⓇ (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED10Gy (BED10Gy95% and BED10Gy90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V83Gy, V103Gy, V123Gy and V243Gy) to the normal brain were evaluated by a Wilcoxon-signed rank test.
RESULTS
For RC + 0 mm, median BED10Gy 90% for STaRT (90.1 Gy10, range: 64.1–140.9 Gy10) was significantly higher than CK (74.3 Gy10, range:59.3–80.4 Gy10, p = 0.04), GK (69.4 Gy10, range: 59.8–77.1 Gy10, p = 0.005), and IMPT (49.3 Gy10, range: 49.0–49.7 Gy10, p = 0.003), respectively. However, for the RC + 5 mm, the median BED10Gy 90% for STaRT (34.1 Gy10, range: 22.2–59.7 Gy10) was significantly lower than CK (44.3 Gy10, range: 37.8–52.4 Gy10), and IMPT (46.6 Gy10, range: 45.1–48.5 Gy10), respectively, but not significantly different from GK (34.1 Gy10, range: 22.8–47.0 Gy10). The median V243Gy was significantly higher in CK (11.7 cc, range: 4.7–20.1 cc), GK(6.2 cc, range: 2.3–11.9 cc) and IMPT (19.9 cc, range: 11.1–36.6 cc) compared to STaRT (1.1 cc, range: 0.0–7.8 cc) (p < 0.01).
CONCLUSIONS
This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.
{"title":"Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities","authors":"Tugce Kutuk , Rupesh Kotecha , Roberto Herrera , D Jay J. Wieczorek , Zachary W. Fellows , Vibha Chaswal , Alonso La Rosa , Vivek Mishra , Michael W. McDermott , Vitaly Siomin , Minesh P. Mehta , Alonso N. Gutierrez , Ranjini Tolakanahalli","doi":"10.1016/j.brachy.2024.06.007","DOIUrl":"10.1016/j.brachy.2024.06.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities.</div></div><div><h3>METHODS</h3><div>Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnife<sup>Ⓡ</sup> (CK), Gamma Knife<sup>Ⓡ</sup> (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED<sub>10Gy</sub> (BED<sub>10Gy</sub>95% and BED<sub>10Gy</sub>90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V8<sub>3Gy</sub>, V10<sub>3Gy</sub>, V12<sub>3Gy</sub> and V24<sub>3Gy</sub>) to the normal brain were evaluated by a Wilcoxon-signed rank test.</div></div><div><h3>RESULTS</h3><div>For RC + 0 mm, median BED<sub>10Gy</sub> 90% for STaRT (90.1 Gy<sub>10</sub>, range: 64.1–140.9 Gy<sub>10</sub>) was significantly higher than CK (74.3 Gy<sub>10</sub>, range:59.3–80.4 Gy<sub>10</sub>, <em>p =</em> 0.04), GK (69.4 Gy<sub>10</sub>, range: 59.8–77.1 Gy<sub>10</sub>, <em>p =</em> 0.005), and IMPT (49.3 Gy<sub>10</sub>, range: 49.0–49.7 Gy<sub>10</sub>, <em>p =</em> 0.003), respectively. However, for the RC + 5 mm, the median BED<sub>10Gy</sub> 90% for STaRT (34.1 Gy<sub>10</sub>, range: 22.2–59.7 Gy<sub>10</sub>) was significantly lower than CK (44.3 Gy<sub>10</sub>, range: 37.8–52.4 Gy<sub>10</sub>), and IMPT (46.6 Gy<sub>10</sub>, range: 45.1–48.5 Gy<sub>10</sub>), respectively, but not significantly different from GK (34.1 Gy<sub>10</sub>, range: 22.8–47.0 Gy<sub>10</sub>). The median V24<sub>3Gy</sub> was significantly higher in CK (11.7 cc, range: 4.7–20.1 cc), GK(6.2 cc, range: 2.3–11.9 cc) and IMPT (19.9 cc, range: 11.1–36.6 cc) compared to STaRT (1.1 cc, range: 0.0–7.8 cc) (<em>p</em> < 0.01).</div></div><div><h3>CONCLUSIONS</h3><div>This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 751-760"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.07.001
Christine March , Maximilian Thormann , Peter Hass , Marilena Georgiades , Maximilian Sensse , Tim Herrmann , Jazan Omari , Maciej Pech , Robert Damm
PURPOSE
Ablative therapies for primary and secondary liver malignancies are increasingly adopted in current guidelines. Nevertheless, surgical resection remains the gold standard in most curative therapy settings.
Extensive studies on mortality and morbidity after ablative treatment of the liver are missing. We investigated complications and mortality after ablative treatment in a large, unselected study cohort.
MATERIALS AND METHODS
Standardized patient and treatment data in 4374 percutaneous and angiographic ablative procedures of the liver from the DRG-based hospital reimbursement system (diagnosis-related groups) of an academic hospital in Germany were retrospectively evaluated. We analyzed descriptive patient data, length of stay (LOS), pre-existing medical conditions, previous gastrointestinal surgeries, severe complications, and occurrence of death.
RESULTS
Treatment of secondary liver malignancies constituted over two-thirds of all procedures (71%, n = 3053). The mean LOS was 4.1 ± 3.5 days. Severe complications were documented in 1.4% and in-house death in 0.2% of cases, significantly more often after treatment with chemoembolization of primary liver malignancies (p = 0.003; p = 0.0001).
Previous partial liver resection, partial bowel resection, and chronic renal failure were independent risk factors for the occurrence of severe complications.
CONCLUSION
Severe complications and in-hospital death are rare in the treatment of primary and secondary liver malignancies with percutaneous and angiographic procedures.
They are a viable alternative or addition to a surgical approach in treating liver lesions.
{"title":"Mortality and postinterventional complications after ablative treatment of liver malignancies: A cohort study of 4374 patients","authors":"Christine March , Maximilian Thormann , Peter Hass , Marilena Georgiades , Maximilian Sensse , Tim Herrmann , Jazan Omari , Maciej Pech , Robert Damm","doi":"10.1016/j.brachy.2024.07.001","DOIUrl":"10.1016/j.brachy.2024.07.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Ablative therapies for primary and secondary liver malignancies are increasingly adopted in current guidelines. Nevertheless, surgical resection remains the gold standard in most curative therapy settings.</div><div>Extensive studies on mortality and morbidity after ablative treatment of the liver are missing. We investigated complications and mortality after ablative treatment in a large, unselected study cohort.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Standardized patient and treatment data in 4374 percutaneous and angiographic ablative procedures of the liver from the DRG-based hospital reimbursement system (diagnosis-related groups) of an academic hospital in Germany were retrospectively evaluated. We analyzed descriptive patient data, length of stay (LOS), pre-existing medical conditions, previous gastrointestinal surgeries, severe complications, and occurrence of death.</div></div><div><h3>RESULTS</h3><div>Treatment of secondary liver malignancies constituted over two-thirds of all procedures (71%, n = 3053). The mean LOS was 4.1 ± 3.5 days. Severe complications were documented in 1.4% and in-house death in 0.2% of cases, significantly more often after treatment with chemoembolization of primary liver malignancies (<em>p</em> = 0.003; <em>p</em> = 0.0001).</div><div>Previous partial liver resection, partial bowel resection, and chronic renal failure were independent risk factors for the occurrence of severe complications.</div></div><div><h3>CONCLUSION</h3><div>Severe complications and in-hospital death are rare in the treatment of primary and secondary liver malignancies with percutaneous and angiographic procedures.</div><div>They are a viable alternative or addition to a surgical approach in treating liver lesions.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 743-750"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.05.004
Xiaolu Zhu , Manting Zeng , Youyi Dai , Weilu Kuang , Zijian Zhang , Shan Li , Hong Zhu
OBJECTIVE
The prognosis of recurrent cervical cancer tends to be poor and there are limited effective treatments currently available for these patients. This study was developed to find a safe and effective treatment for patients with central pelvic recurrent cervical cancer.
MATERIALS AND METHODS
This retrospective study analyzed patients with central pelvic recurrent cervical cancer who received 3D-printed individual template (3D-PIT) brachytherapy between February 2019 and June 2023. Analyses of dosimetric parameters, toxicity-related complications, and survival were conducted based on the data of these patients.
RESULTS
Twenty-one patients with central pelvic recurrent cervical cancer patients were enrolled. All of them received 3D-printed individual template (3D-PIT) brachytherapy. The mean respective adjusted cumulative HRCTV-D90 and HRCTV-D98 values for these patients were 86.9 Gy and 75.4 Gy. And the local control (LC) rate of these patients was 57.1%. In these 21 patients, only 2 (9.5%) of them experienced grade 3–4 rectal adverse reactions, while 7 (33.3%) patients experienced grade 3–4 bladder adverse reactions. 5(23.8%) patients had fistula, while 3 of these 5 patients had undergone prior anti-VEGF targeted drug treatment which is a risk factor of fistula. The respective 2-year rates of overall and progression-free survival (OS and PFS) for these patients were 72.9% and 57.4%, with a 26-month median PFS.
CONCLUSIONS
These single-institution data highlight the potential viability of 3D-PIT brachytherapy as an approach to managing intractable central pelvic recurrent cervical cancer following first-line treatment.
{"title":"3D-printed individual template brachytherapy for the treatment of intractable central pelvic recurrent cervical cancer: A single institution experience","authors":"Xiaolu Zhu , Manting Zeng , Youyi Dai , Weilu Kuang , Zijian Zhang , Shan Li , Hong Zhu","doi":"10.1016/j.brachy.2024.05.004","DOIUrl":"10.1016/j.brachy.2024.05.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>The prognosis of recurrent cervical cancer tends to be poor and there are limited effective treatments currently available for these patients. This study was developed to find a safe and effective treatment for patients with central pelvic recurrent cervical cancer.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This retrospective study analyzed patients with central pelvic recurrent cervical cancer who received 3D-printed individual template (3D-PIT) brachytherapy between February 2019 and June 2023. Analyses of dosimetric parameters, toxicity-related complications, and survival were conducted based on the data of these patients.</div></div><div><h3>RESULTS</h3><div>Twenty-one patients with central pelvic recurrent cervical cancer patients were enrolled. All of them received 3D-printed individual template (3D-PIT) brachytherapy. The mean respective adjusted cumulative HRCTV-D90 and HRCTV-D98 values for these patients were 86.9 Gy and 75.4 Gy. And the local control (LC) rate of these patients was 57.1%. In these 21 patients, only 2 (9.5%) of them experienced grade 3–4 rectal adverse reactions, while 7 (33.3%) patients experienced grade 3–4 bladder adverse reactions. 5(23.8%) patients had fistula, while 3 of these 5 patients had undergone prior anti-VEGF targeted drug treatment which is a risk factor of fistula. The respective 2-year rates of overall and progression-free survival (OS and PFS) for these patients were 72.9% and 57.4%, with a 26-month median PFS.</div></div><div><h3>CONCLUSIONS</h3><div>These single-institution data highlight the potential viability of 3D-PIT brachytherapy as an approach to managing intractable central pelvic recurrent cervical cancer following first-line treatment.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 634-640"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.06.010
Gil'ad N. Cohen , Xiuxiu He , Michael Trager , Maria F. Chan , Jeonghoon Park , Antonio L. Damato , David Aramburu Nunez
BACKGROUND And PURPOSE
The upgrade of major equipment can be disruptive to clinical operations and introduce risk as policy and procedures need to adapt to new technical possibilities and constraints. We describe here the transition from GammaMedPlus-iX to Bravos in a busy brachytherapy clinic, involving four afterloaders across two sites.
MATERIAL And METHODS
Our clinic employs three high-dose-rate remote afterloaders in four dedicated treatment vaults at the main site and a fourth afterloader at a regional location. Of more than 600 new HDR treatment plans performed annually, most are planned and treated intraoperatively. Most treatments are for prostate cancer, followed by GYN, intraoperative brachytherapy, GI, and other sites. Applicators used include vendor-provided applicators as well as third party applicators and in-house 3D-printed devices to provide interstitial, intracavitary, intraluminal, and surface treatments. All applicators were commissioned according to recommended guidelines. The choice of tolerances and the design of new procedures were informed by current guidelines and leveraged new HDR afterloader functionalities. A review of clinical operations in the 4 months postupgrade was conducted to evaluate the feasibility of new tolerances and the effectiveness of new procedures.
RESULTS
The procedures outlined improved and standardized afterloader QA and treatment protocols with clear actionable steps for staff to follow to ensure treatments are delivered as planned. Re-commissioning of applicators yielded results similar to those previously reported by other investigators. A review of initial treatment data revealed that in one case, due to the implementation of tight tolerances, obstruction near the tip of the channel was detected and corrected prior to treatment. It confirms that the implementation of the tolerances adopted is feasible and effective in flagging treatment deviations.
CONCLUSION
Enhanced procedures and QA processes were implemented successfully. We established clear actionable steps to follow by staff to ensure that treatments are delivered accurately.
{"title":"Commissioning considerations for the Bravos high-dose-rate afterloader: Towards improving treatment delivery accuracy","authors":"Gil'ad N. Cohen , Xiuxiu He , Michael Trager , Maria F. Chan , Jeonghoon Park , Antonio L. Damato , David Aramburu Nunez","doi":"10.1016/j.brachy.2024.06.010","DOIUrl":"10.1016/j.brachy.2024.06.010","url":null,"abstract":"<div><h3>BACKGROUND And PURPOSE</h3><div>The upgrade of major equipment can be disruptive to clinical operations and introduce risk as policy and procedures need to adapt to new technical possibilities and constraints. We describe here the transition from GammaMed<em>Plus</em>-iX to Bravos in a busy brachytherapy clinic, involving four afterloaders across two sites.</div></div><div><h3>MATERIAL And METHODS</h3><div>Our clinic employs three high-dose-rate remote afterloaders in four dedicated treatment vaults at the main site and a fourth afterloader at a regional location. Of more than 600 new HDR treatment plans performed annually, most are planned and treated intraoperatively. Most treatments are for prostate cancer, followed by GYN, intraoperative brachytherapy, GI, and other sites. Applicators used include vendor-provided applicators as well as third party applicators and in-house 3D-printed devices to provide interstitial, intracavitary, intraluminal, and surface treatments. All applicators were commissioned according to recommended guidelines. The choice of tolerances and the design of new procedures were informed by current guidelines and leveraged new HDR afterloader functionalities. A review of clinical operations in the 4 months postupgrade was conducted to evaluate the feasibility of new tolerances and the effectiveness of new procedures.</div></div><div><h3>RESULTS</h3><div>The procedures outlined improved and standardized afterloader QA and treatment protocols with clear actionable steps for staff to follow to ensure treatments are delivered as planned. Re-commissioning of applicators yielded results similar to those previously reported by other investigators. A review of initial treatment data revealed that in one case, due to the implementation of tight tolerances, obstruction near the tip of the channel was detected and corrected prior to treatment. It confirms that the implementation of the tolerances adopted is feasible and effective in flagging treatment deviations.</div></div><div><h3>CONCLUSION</h3><div>Enhanced procedures and QA processes were implemented successfully. We established clear actionable steps to follow by staff to ensure that treatments are delivered accurately.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 705-711"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A new mobile cone beam computed tomography (CBCT) imaging ring (IRm, Elekta, v2.10.6, Veenendaal, Netherlands) has recently been proposed for brachytherapy to improve procedure efficiency. We describe the commissioning process and end-to-end tests for GYN HDR brachytherapy employing IRm CBCT imaging.
MATERIALS AND METHODS
Commissioning included imaging isocenter test, 3D image quality, 2D imaging quality, image dose, and tube characteristics. CIRS HDR GYN phantom and Venezia CT/MR gynecological applicator were used to perform end-to-end (E2E) tests and optimize workflow. Venezia applicator and four interstitial needles were inserted into the phantom and IRm CBCT images were acquired. Phantom and applicator were scanned with CT scanner (Siemens SOMATOM go.Open Pro) using department's pelvis imaging protocol. MR imaging was performed using 0.35T MR Linac TRUFI pulse sequence. CBCT images were registered to CT and MR using rigid registration to assess image quality and applicator geometry fidelity.
RESULTS
All physics tests passed within acceptance tolerances. Registration of CBCT images to MR and CT scans was acceptable for applicator placement. Applicator registration of CBCT images to CT demonstrated excellent agreement of most distal source dwell position (<1 mm). Slice thickness was also measured to be 1.25 mm, within 0.5 mm of its nominal value.
CONCLUSION
Based on E2E and commissioning results, IRm is an appropriate tool for brachytherapy treatment planning. This study demonstrated good image quality in GYN phantom and Venezia applicator using the IRm. Distal source dwell position agreement between CBCT and CT was acceptable for clinical use.
{"title":"Comprehensive commissioning of a cone beam CT imaging ring for treatment of HDR GYN patients","authors":"Cullen Boyle, Firas Mourtada, Rani Anne, Shuying Wan, Yingxuan Chen, Yevgeniy Vinogradskiy, Reza Taleei","doi":"10.1016/j.brachy.2024.07.008","DOIUrl":"10.1016/j.brachy.2024.07.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>A new mobile cone beam computed tomography (CBCT) imaging ring (IRm, Elekta, v2.10.6, Veenendaal, Netherlands) has recently been proposed for brachytherapy to improve procedure efficiency. We describe the commissioning process and end-to-end tests for GYN HDR brachytherapy employing IRm CBCT imaging.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Commissioning included imaging isocenter test, 3D image quality, 2D imaging quality, image dose, and tube characteristics. CIRS HDR GYN phantom and Venezia CT/MR gynecological applicator were used to perform end-to-end (E2E) tests and optimize workflow. Venezia applicator and four interstitial needles were inserted into the phantom and IRm CBCT images were acquired. Phantom and applicator were scanned with CT scanner (Siemens SOMATOM go.Open Pro) using department's pelvis imaging protocol. MR imaging was performed using 0.35T MR Linac TRUFI pulse sequence. CBCT images were registered to CT and MR using rigid registration to assess image quality and applicator geometry fidelity.</div></div><div><h3>RESULTS</h3><div>All physics tests passed within acceptance tolerances. Registration of CBCT images to MR and CT scans was acceptable for applicator placement. Applicator registration of CBCT images to CT demonstrated excellent agreement of most distal source dwell position (<1 mm). Slice thickness was also measured to be 1.25 mm, within 0.5 mm of its nominal value.</div></div><div><h3>CONCLUSION</h3><div>Based on E2E and commissioning results, IRm is an appropriate tool for brachytherapy treatment planning. This study demonstrated good image quality in GYN phantom and Venezia applicator using the IRm. Distal source dwell position agreement between CBCT and CT was acceptable for clinical use.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 687-697"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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